Healthcare Provider Details

I. General information

NPI: 1891204871
Provider Name (Legal Business Name): ANN BROOK ROGERS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN BROOK THEODORE RN

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 NICHOLAS ST STE 106
OMAHA NE
68114-2188
US

IV. Provider business mailing address

10020 NICHOLAS ST STE 106
OMAHA NE
68114-2188
US

V. Phone/Fax

Practice location:
  • Phone: 402-226-5211
  • Fax: 877-325-2308
Mailing address:
  • Phone: 402-226-5211
  • Fax: 877-325-2308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number72934
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number112528
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA127580
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: